COVID-19 Vaccination, Supply Chain and Concerns on Vaccine Hesitancy in Africa

Vaccine Hesitancy in Africa

By King Carl Tornam Duho, Anna Taylor, Dr Rosemond Sussana Amamoo and Dr Roselyn Salomey Amamoo

The drivers of the economic crisis from the pandemic differ from what transpired during the 2007-8 global financial crisis. The clear similarity is that the impact of both has been dire on economies leading to economic recession and aside from the Great Depression and the 2007-8 crisis this health crisis is one of the worse economic crises. As a health crisis with socio-economic implications, the impact on the world, developed economies, and developing economies continue to receive policy attention. In this article, we explore the state of COVID-19 vaccination in Africa, the supply chain issues and the concerns on vaccine hesitancy when the vaccines become available. We provide relevant insights for policymakers and practitioners.

Introduction

Aside from the financial crisis of 2007-8, the current health crisis is a global event that has impacted economies and livelihoods adversely.[1] In Africa, the impact of the pandemic has been mild initially but there are fears as this is changing because new variants are being recognized amid low levels of vaccination. Health statistics in Africa is generally not detailed as compared to developed countries. After more than 1 year of the pandemic, only about 1.7% of the African population has been vaccinated, while the majority of the citizens are still left without access to the vaccines.[2] There are different dimensions of the issues of policy relevance including public health concerns, the economic impact, the supply chain issues and public procurement issues, among others. We discussed the COVID-19 variants reported in Africa, the state of vaccination, supply chain issues and the COVID-19 hesitancy issues that practitioners and policymakers need to consider.

COVID-19 Variants and Spread in Africa

The novel coronavirus, SARS-COV 2 also known as COVID-19 has evolved via mutation as most viruses normally do. Changes in the characteristics of viruses affect not only their virulence but may also cause resistance to some medications used in the treatment of diseases caused by these viruses. Differences in the genome sequencing of the genetic material of the virus have led to the discovery of many variants of COVID-19.

The World Health Organization (WHO) in collaboration with some partners and institutions have been assessing and monitoring the evolution of SARS-COV 2 worldwide and as of July 2021, have established four variants of concern namely, Alpha, Beta, Gamma and Delta variants.[3]  It is quite interesting to note that the Beta variant was first detected in South Africa in May 2020 while the others were first detected outside Africa. There are still new variants like the Lambda, the MU (formerly known as B.1.621) and others which are yet to be discovered.

With Africa currently experiencing its third wave of COVID-19, as of the 5th of August 2021, the highly contagious Delta variant which is about 30%-60% more transmissible than the other variants[4] had been discovered in 29 African countries including Ghana, Uganda and the Democratic Republic of Congo.[5] The Alpha and Beta variants have been discovered in 39 and 35 African countries respectively.[6] The Alpha variant is predominantly found in Northern, Western and Central Africa[7] and the Beta variant in Southern Africa[8] with only one African country[9] reporting the Gamma variant.

Current State of COVID-19 Vaccination in Africa

Out of the 4 billion vaccine doses administered globally, about 80% are in high- and middle-income countries (See the Figure).[10] Most African countries are depending on the African Union and WHO’s bid to ensure global equity in terms of access to COVID-19 vaccines through COVID-19 Vaccines Global Access (COVAX).

WHO’s target to have 20% of the African population vaccinated by the end of 2021 looks impossible since less than 2% have this as a reality.[11] For instance, COVAX is lagging on its promise to Ghana of at least 2 million vaccine doses in 2021.[12] As of 24th August 2021, only 950,000 doses of SII-AstraZeneca (COVISHIELD) vaccine doses were delivered to Ghana.[13] The delay could be explained by vaccine nationalism and India’s diversion of vaccines for domestic rollouts.[14] 

figure 1

Developing countries, some of which have none of their population fully vaccinated have to compete with the high- and middle-income countries who already have vastly immunized populations.[15] Sadly, amidst the global shortage of vaccines, a couple of developed countries like Europe and the US[16] desire to give booster doses despite the WHO’s calls for a moratorium.[17]

Supply Chain and Vaccine Distribution in Africa

Most African countries that have started the vaccination have acquired their vaccines under the COVAX scheme backed by the WHO and other international organisations.[18] These vaccines were mostly sourced from the Serum Institute of India, which at a point channelled their production towards the demand of India as a result of the surge in COVID-19 infection rate. This resulted in a short supply for African countries.

According to the WHO, to fully vaccinate 10% of the African population by September 2021, 183 million doses are needed and about 729 million more to reach 30% of the African population by the end of the year.[19] Though the distribution of vaccines has been slow due to some challenges arising from inadequate staff and infrastructure, there is also the issue of some individuals and countries not being willing to get vaccinated.

Another challenge has been with the storage and life span of the vaccines received in Africa. Some countries have had to dispose of some of their vaccines because they were unable to use them before expiry.[20] Others have had to return some because they could not have used them all up by the date of expiry.

Most African countries are using AstraZeneca/COVISHIELD which is expected to be in an environment with a temperature between 2oC to 8oC and an upright position during transportation and storage.[21] It has a shelf life of up to 6 months when not opened and must not be exposed to direct sunlight. Besides, J&J/Janssen COVID-19 Vaccine allows for a single shot, all the other vaccines allow for 2 shots for full vaccination (See Figure 2).

figure 2

Since the inception of this pandemic, the World Bank Group has approved more than $150 billion to battle health, economic and social effects experienced as a result of COVID-19 and even scaled the financing up by 50% in April 2020 to serve as an aid to over 100 countries.[22] The International Monetary Fund (IMF) recently approved its largest Special Drawing Rights (SDR) of S$650 billion to countries, the largest in its history.[23]

Though the WHO is trying its best in the fight against COVID-19, there is a lot of room for improvement especially with regards to Africa and vaccination. Per the third Sustainable Development Goal (SDG #3), which is concerned with Good Health and Well-being, the world should attain universal health coverage by 2030.[24] This covers the accessibility of quality essential healthcare services and also of safe, effective, quality and affordable essential medicines and vaccines for all. The current events are a signal that SDG #3 might not be attainable, especially in the context of Africa and the Global South.

Aside from the fact that the vaccination drive in Africa is slow compared to other regions of the world, research and development (R&D) in the continent is lagging (See Figure 3). Most African countries are not able to allocate 1% of their Gross Domestic Product to R&D, leading to a lack of innovation and a culture of dependence on the Western world.

figure 3

Concerns of Vaccine Hesitancy in Africa

Vaccine hesitancy is a health policy issue that can be linked to the late 16th century when vaccines were introduced. It covers the delay in acceptance of vaccines or the refusal in the face of availability of vaccination services. Five factors drive hesitancy, namely 1) confidence of people in the safety and effectiveness of the vaccines, 2) complacency when the vaccines are not deemed as a prevention measure, 3) convenience[25] which relates to how appealing the vaccination services are, 4) communication as there is the need to combat misinformation and 5) the fact that context matters especially for the pro-poor, and marginalized groups.[26]

Currently, because of the limited number of vaccines available to Africans, there are no clear indications of hesitancy but as vaccines are made available there will be a need to devise strategies to reach the people who will refuse to be vaccinated, an essential factor to reaching herd immunity.[27] The treated meted out to Africa is counterintuitive for a world that is pursuing sustainable development that aims to leave no one behind. This is because the vaccine narrative has been a story of inequality, poverty, scarcity, shortage, denial, deficiency, or deprivation for Africa.[28]

Vaccine hesitancy in Africa will result in the pandemic of the unvaccinated as is being reported in the US.[29] For African policymakers, policies should be devised to address the possible escalation of vaccine hesitancy amidst propaganda and conspiracies. Attention should also be placed significantly on the procurement and administration of vaccines, as lack of transparency and accountability can result in corrupt actions regarding procurement which is a top source of corrupt activities.

Policy Recommendations

There are some notable policy and practical issues that need to be focus areas for policymakers and practitioners to enhance the vaccination drive and post-COVID-19 recovery for African countries.

  • Policymakers should provide efficient systems and enhance the capacity of health professionals to handle the vaccines appropriately.
  • The concerns of inequality and deprivation of African countries need to be addressed through better vaccine diplomacy where developed countries provide optimal support for the developing countries to address the health crisis.
  • The Finance and Health Ministries and other related ministries in African countries should be committed to following public procurement best practices in acquiring the vaccines. This is essential as already the pandemic has deepened the debt unsustainability of countries, and increasing corruption will be detrimental to countries.
  • Policymakers need to engage the media, civil society organisations and community level leaders in promoting the vaccination drive. There should be strategies to reach the poor and vulnerable people.
  • The business community in Africa should be committed to providing support in-kind and cash to help the government in achieving the needed level of vaccination that can achieve herd immunity. Such supports fit within the sustainability efforts of businesses and managers should do well to showcase them in their sustainability reports.

About the Authors

King Carl Tornam Duho

King Carl Tornam Duho is an ACCA Prize-winner, CIMA Qualified Accountant, award-winning reviewer and a business, economic, and research consultant with experience in academia, business and public policy. He is the Technical Director for Dataking Consulting. King has published more than 30 articles including more than 15 in CABS/ABDC ranked journals. He holds a Bachelor of Science and Master of Philosophy degrees in accounting.

Anna Taylor

Anna Taylor, a Supply Chain Analyst with Dataking Research Lab, works as Finance and Administrative Officer at Accra Medical Centre. She holds an MBA in Supply Chain and Logistics Management and a Bachelor’s in Management Studies. Anna is also part-qualified with the Institute of Chartered Accountants Ghana and has interests in both supply chain and finance issues that plague Africa and the world at large.

Dr Rosemond Sussana Amamoo

Dr Rosemond Sussana Amamoo is a medical practitioner currently working with a pediatric hospital and is passionate about global health policy. She holds a Bachelor of Science in Medical Sciences, a Bachelor of Medicine and a Bachelor of Surgery (MBChB) degrees. Rosemond works as a health policy analyst with Dataking Research Lab. Her interest is to explore existing and potential health policies in the Global South.

Dr Roselyn Salomey Amamoo

Dr Roselyn Salomey Amamoo is a medical practitioner in Ghana with an interest in public health, emphasis on Epidemiology. She has degrees in Bachelor of Science in Human Biology, a Bachelor of Medicine and a Bachelor of Surgery (MBChB). She also holds certificates in Epidemiology and Fundamentals of Global Health Research from the University of Washington. Roselyn is a health policy analyst with Dataking Research Lab and hopes her work impacts the world at large.

References

[1] Gopinath, G (2020), “The Great Lockdown: Worst Economic Downturn Since the Great Depression”, International Monetary Fund. https://blogs.imf.org/2020/04/14/the-great-lockdown-worst-economic-downturn-since-the-great-depression/

[2] UN (2021), “COVID-19: Africa ‘third wave’ not yet over, while vaccine inequity threatens all”, United Nations. https://news.un.org/en/story/2021/07/1096252

[3] WHO (2021), “Tracking SARS-CoV-2 variants”, World Health Organisation. https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/

[4] WHO (2021), “Rife COVID-19 variants fuel Africa’s surging wave”, World Health Organisation. https://www.afro.who.int/news/rife-covid-19-variants-fuel-africas-surging-wave [Rife]

[5] WHO (2021), “Record weekly COVID-19 deaths in Africa”, World Health Organisation. https://www.afro.who.int/news/record-weekly-covid-19-deaths-africa

[6] Ibid.

[7] Rife supra note 4

[8] Ibid.

[9] Africa CDC, (2021), “Opening Remarks, Weekly Press Briefing on COVID-19 in Africa, 05 August 2021”, Africa Centres for Disease Control and Prevention. https://africacdc.org/speech/weekly-press-briefing-on-covid-19-in-africa-2/

[10] WHO (2021), “WHO Director-General’s opening remarks at the media briefing on COVID-19 – 4 August 2021”, World Health Organisation. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-4-august-2021

[11] WHO, (2021), “COVID-19 vaccine shipments to Africa ramp up”, World Health Organisation. https://www.afro.who.int/news/covid-19-vaccine-shipments-africa-ramp

[12] WHO, (2021), “COVID-19 vaccine doses shipped by the COVAX Facility head to Ghana, marking beginning of global rollout”, World Health Organisation. https://www.who.int/news/item/24-02-2021-covid-19-vaccine-doses-shipped-by-the-covax-facility-head-to-ghana-marking-beginning-of-global-rollout

[13] GAVI, (2021), “COVAX vaccine roll-out – GHANA”, Gavi, The Vaccine Alliance. https://www.gavi.org/covax-vaccine-roll-out/ghana

[14] Mwai, P. (2021), “Covid-19 Africa: What is happening with vaccine supplies?”, BBC News. https://www.bbc.com/news/56100076 [Mwai]

[15] Myers, J. (2021), “This is how much work is left to vaccinate the world against COVID-19”, World Economic Forum. https://www.weforum.org/agenda/2021/08/this-is-how-much-work-is-left-to-vaccinate-the-world/

[16] Furlong, A. and Deutsch, J. (2021), “A country-by-country guide to coronavirus vaccine booster plans”, POLITICO. https://www.politico.eu/article/vaccine-booster-coronavirus-covid-19-europe-delta-varian-who/

[17] WHO, (2021), “WHO calls for moratorium on COVID-19 booster jabs”, World Health Organisation. https://news.un.org/en/story/2021/08/1097102

[18] Mwai supra note 14

[19] Ibid.

[20] Mwai, P. (2021), “Covid-19 vaccines: Why some African states can’t use their vaccines”, BBC News. https://www.bbc.com/news/56940657

[21] BCDC (2021), “COVID-19 AstraZeneca/Covishield Shipping, Storage, and Use Guidelines”, British Columbia Centre for Disease Control. http://www.bccdc.ca/Health-Professionals-Site/Documents/COVID-19_vaccines/SOPs/AstraZeneca_Storage_Thawing_Use.pdf

[22] WBG, (2021), “World Bank Financing for COVID-19 Vaccine Rollout Exceeds $4 Billion for 50 Countries”, World Bank Group. https://www.worldbank.org/en/news/press-release/2021/06/30/world-bank-financing-for-covid-19-vaccine-rollout-exceeds-4-billion-for-50-countries

[23] IMF (2021), “IMF Governors Approve a Historic US$650 Billion SDR Allocation of Special Drawing Rights”, International Monetary Fund. https://www.imf.org/en/News/Articles/2021/07/30/pr21235-imf-governors-approve-a-historic-us-650-billion-sdr-allocation-of-special-drawing-rights

[24] UN, (2021), “#Envision2030 Goal 3: Good Health and Well-being”, United Nations. https://www.un.org/development/desa/disabilities/envision2030-goal3.html

[25] MacDonald, N. E. (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33(34), 4161-4164. https://dx.doi.org/10.1016/j.vaccine.2015.04.036

[26] Razai, M. S., Oakeshott, P., Esmail, A., Wiysonge, C. S., Viswanath, K., & Mills, M. C. (2021). COVID-19 vaccine hesitancy: the five Cs to tackle behavioural and sociodemographic factors. Journal of the Royal Society of Medicine, 114(6), 295-298. https://doi.org/10.1177%2F01410768211018951

[27] McEvoy, J. (2021), “Fauci: Herd Immunity Unreachable Unless Vaccine Hesitant Get the Jab or Get Infected”, Forbes. https://www.forbes.com/sites/jemimamcevoy/2021/08/24/fauci-herd-immunity-unreachable-unless-vaccine-hesitant-get-the-jab-or-get-infected/?sh=15e30f2d2605

[28] UN ECOSOC, (2021), “Unequal Vaccine Distribution Self-Defeating, World Health Organization Chief Tells Economic and Social Council’s Special Ministerial Meeting”, United Nations Economic and Social Council. https://www.un.org/press/en/2021/ecosoc7039.doc.htm

[29] Cobb, J.S. (2021), “Americas are facing pandemic of the unvaccinated, PAHO says”, Reuters. https://www.reuters.com/world/americas/americas-is-facing-pandemic-unvaccinated-paho-says-2021-07-21/

The views expressed in this article are those of the authors and do not necessarily reflect the views or policies of The World Financial Review.